Des Spence believes that the rising prescription rates for antidepressants reflect overmedicalisation, but Ian Reid (doi:10.1136/bmj.f190) argues that prescribing is cautious and appropriate

Antidepressant prescriptions in the UK jumped by 9.6% in 2011, to 46 million prescriptions.1 As a generalist prescribing antidepressants daily in primary care, I think that we use antidepressants too easily, for too long, and that they are effective for few people (if at all). But even questioning current care is considered “stigmatising” towards mental illness and “populist” anti-medicine rhetoric.2 The arguments put forward for using antidepressants are simple: depression is an important, often stigmatised, illness, for which antidepressants work; prescribing is supported by national guidelines; and long term treatment prevents relapse.23 But, regrettably, the argument is not that simple, and psychiatry’s defensiveness is stifling legitimate discussion.

Question of definition

Depression is indeed an important illness; few of us are untouched. But the current definition of depression is too loose and is causing widespread medicalisation. The Diagnostic and Statistical Manual of Mental Disorders (both DSM-IV and the proposed DSM-5) suggests defining two weeks …

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